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Mental Health Nursing Assignment Sample

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1.0 Introduction

The following piece takes the form of a reflective analysis of personal development,

using the Gibbs’ (1988) Reflective Cycle as a model. The Gibbs’ cycle can be

represented as is shown in figure 1. The ‘Reflective Cycle’ part of this piece follows

the headings as they are represented in figure 1. This is followed by a section

entitled ‘Overall Conclusion’. The focus of this reflexive piece is a student nurse

overcoming the fear of administering intramuscular (IM) injections with the help of a

mentor.

This report mentions three individuals: a student mental health nurse, a mentor, and

– very briefly – a patient. For the purposes of upholding patient confidentiality in line

with the MNC code of conduct (NMC, 2008), the name of the patient is omitted. In

order to protect privacy, also omitted is the name of the mentor.


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2.0 The Reflective Cycle

2.1 Description

Injections have always been something that I have been nervous about, but I had

pushed the fear to the back of my mind. In particular, I had fears about administering

the injection in the wrong place, of hurting the patient, and of dealing with a patient

who had a fear of needles or who was otherwise distressed. Even though I knew that

I would have to address these concerns eventually, I had preferred to focus on

building up my confidence in other areas of nursing. To that end, I had turned down

every opportunity that had been presented to me to administer an IM injection. This

did not go unnoticed, and my personal mentor eventually raised the issue with me.

Resultantly, the mentor and I constructed a plan that would enable me to reach the

stage where I would be able to administer depot injections with confidence and

without fear.

According to Hargie (2010), overcoming fear can be aided by knowledge. Therefore,

the first part of the plan involved improving my knowledge of the entire process,

including learning about how depot injections work, and how to prepare and

administer the medication. This was done at first with text book examples, but I

quickly moved on to practicing preparing the medication myself, and using an orange

as a sample ‘patient’. This built my confidence to the point where I was able to

administer the depot medication to a genuine patient, who had been selected by my

mentor and who had said that they were happy with being the first patient that a

student nurse had given a depot injection to. This IM injection was supervised by my

mentor, who then gave me one-to-one feedback. I was then given time to reflect


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upon my feelings, and to discuss these with my mentor. This process is shown in

figure 2.

2.2 Feelings

Even before I became a nurse I had been dreading the day that I would have to give

a patient an IM injection. This made me feel anxious both physically and emotionally.

I was relieved that opportunities to administer an IM were comparatively rare, and

that over time I had successfully managed to avoid such a situation. As I became

more confident in other areas of my professional experience, this fear about

administering an IM became more problematic, because I was worried that it would

be noticed by another health professional or by the patient. I have always learned

that patients need their nurses to display professional competence in all areas of

their care, so having a nurse who was unable to perform a basic nursing task would

undoubtedly lead to patients losing their trust in me as a nurse.


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This fear of administering depot injections was something that caused me

considerable embarrassment. In other areas of nursing I had been able to overcome

some of my fears relatively quickly, but this particular fear had simply not gone away.

I was very relieved when my mentor gave me a big smile and told me an anecdote

about her own experience as a trainee nurse. She also put me at ease by saying that

if there was a student nurse who did not have some fear about administering their

first injection, she had yet to meet them. This made me realise that my feelings were

relatively normal, and that it was by not addressing them that I had made them more

problematic .

2.3 Evaluation

The Johari Window (Luft, 1969) is a widely used heuristic cognitive psychology tool

(figure 3). When the different stages of this problem are put into the Window, it is

possible to provide an explanation for what was happening. It is clear that I had

some initial self-awareness about this particular anxiety, but that others did not. As

time progressed, my awareness grew, and so it became a façade situation. This

meant that I could not start to make progress in addressing the issues. As soon as

my mentor became aware of my fear, the problem moved into the public arena, and

it was at this point that I was able to increase my awareness of the issues and in so

doing begin to tackle them. Figure 3 shows my path through the Johari Window.


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This is a process of self-awareness (Freshwater, 2002). In current theory, self-

awareness is a situation wherein we critically evaluate our behaviour in comparison

to known standards and values (Shrives, 2008). In this way, we become objective

evaluators of our behaviour and feelings. According to Rungapadiachy (1999), this

objective process of self-realisation has three interconnected categories: cognitive,

affective, and behavioural. Put simply, that means what a person thinks, feels, and

does. In order to change what a person does, they may need to make affective and

cognitive changes. In order to change how a person feels, they may have to make

behavioural and cognitive changes. This is one of the cornerstones of cognitive

behavioural psychology (CBP) (Shrives, 2008). In my case, once I became aware of

feelings I was able to begin to change my behaviour and thoughts with regards to

administering depot injections.


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In nursing, self-awareness is recognised as being crucial to developing best practice

(Rungapadiachy, 1999; Freshwater, 2002; Shrives, 2008). This does not just relate

to fears about practical aspects of the job. Other areas that are commonly invisible

until self-awareness methods are employed include hidden biases concerning

ethnicity and religion within patient groups, and strong feelings about different types

of patient groups (Shrives, 2008). Once a nurse becomes aware of issues that may

hinder working practice, facilities such as mentors, training programmes, supervision

and support can then be turned to (Freshwater, 2002; Shrives, 2008; DoH, 2001).

2.4 Analysis

A major player in the outcome of this incident was the mentor. According to the

Department of Health (DoH) (2001), a mentor is someone who is qualified in the

necessary field to be able to help students to get the most out of their learning

process. Mentors also supervise and assess student nurses. In nursing, mentoring is

a key way of ensuring that practical information is learned thoroughly, and that the

anxiety of student nurses is reduced (Grossman, 2007). Students will benefit when

mentors provide valid or therapeutic interventions, and when there is a good working

rapport between the student and mentor.

According to Grossman (2007) intervention is the term used to refer to the action that

a mentor takes in order to change the cognitive, affective, or behavioural practice of

an individual. According to Heron (1990), there are two generalised types of

intervention: authoritative and facilitative. Authoritative interventions are ones

wherein the mentor takes control and directs the actions of the person being

mentored (Heron, 1990; Grossman, 2007). This might include giving explicit


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instructions, or giving a demonstration that needs to be followed. In these cases, the

mentor is the active agent and the trainee is passively involved. Facilitative

interventions are the reverse of this, with the overall aim being for the student to take

individual responsibility for their actions (Heron, 1990; Grossman, 2007). This is

often done by a combination of the mentor providing the student with a combination

of informative and supportive interventions.

Informative intervention is the provision of adequate material to enable the trainee to

become knowledgeable about a subject (Heron, 1990; Grossman, 2007). This might

include text books, journal articles, websites, and information about training days.

Supportive information is more abstract, and is generally defined as being something

that brings validation or encouragement to the individual. This tends to be quite

personal, and therefore may involve techniques such as self-disclosure. Self-

disclosure is when the mentor shares a personal anecdote or experience in order to

reassure, encourage, or find a point of comparison with the student (Grossman,

2007). During this process, personal feelings and experiences are shared so that

empathy and non-judgmental attitude can be conveyed. The main benefit of this

approach is that it has a normalising effect on the feelings of the trainee, which then

helps them reach a situation wherein they can address their fear without

embarrassment. According to Shrives (2008), embarrassment is one of the major

barriers to effective development.

This type of intervention is reliant upon numerous variables that can be

unpredictable. Not all students feel comfortable with self-disclosure, and not all

mentors are skilled in selecting the right information to disclose. Communication is a

vital element in both authoritative and facilitative intervention, but facilitative

intervention requires specific skills in listening, reasoning, and empathy.


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Communication is one of the key skills of nursing (Hargie, 2010), and is something

that every nurse is encouraged to develop constantly. However, although

communication is a single word, it has a lot of different elements. These include

listening, hearing, observing, remembering, speaking, body language (including

verbal and non-verbal cues), and understanding (Hargie, 2010). Put simply, this

means focusing very carefully on the other person. Therefore, even something as

simple as a discussion between a mentor and a student requires a large amount of

skill.

Throughout this piece of work, reference has been made to the concept of ‘empathy’.

The Oxford English Dictionary (OED) defines it as being ‘the ability to understand

and share the feelings of another’, but researchers recognise that this is rarely a

straightforward process. According to Kunyk and Olson (2001), there are five main

ways in which empathy can be conceptualised, which can be measured on the

Empathy Scale (Barker, 2003). This scale brings together the opinions of many

different respondents in order to try to define empathy by behaviour. Among the

most important features are tone of voice and giving quick assistance.

The authoritative intervention of clinical supervision is widely used in nursing

(Grossman, 2007). This has the direct benefit of enabling a trained professional to

observe the actions of a trainee, and to direct them towards improvement where

required. The one-to-one mentoring session then provides a chance for critical

reflection and follow-up discussion and distribution of informative material. In the

ideal scenario, authoritative and facilitative mentoring processes are used in tandem

(Grossman, 2007).


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2.5 Conclusion

Having undertaken this process, I feel considerable relief and satisfaction that I have

overcome my fear of administering an IM injection. Furthermore, the process of

critical self-reflection has enabled me to recognise the full value of the mentoring

process. Had I spoken to my mentor earlier, I could have shortened my learning

curve considerably, and would have eliminated the façade phase of my self-

awareness development.

Recognising areas for improvement is a positive rather than a negative realisation.

All people make mistakes, and there are many situations that people wish that they

had approached differently. However, it is by critical reflection and retrospective

analysis that the most effective learning occurs. This is greatly enabled with the aid

of a sympathetic mentor, who can bolster the physical and emotional knowledge

acquisition of a student.

Action Plan

As is mentioned above, a personalised action plan was developed. This used the

SMART model, which is shown in figure 4 below. My personalised plan is attached

as Appendix A.


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Figure 4: the SMART plan

3.0 Overall Conclusion

The aim of this piece of work was to employ reflective thinking methods to a real-life

scenario in order to provide a useful learning text. In particular, this real-life scenario

was one in which a mentor and various accepted reflexive tools were used to

overcome a career barrier.

Overall, it can be seen that the mentor was highly instrumental in enabling me to

progress beyond the situation that I was in. After this, illustrative tools and an action

plan were combined with supportive intervention were used in order to provide me

with the support I needed to overcome my fear. The end result was highly positive:

after performing only two or three supervised IM injections, I felt confident in

performing the procedure alone. Moreover, I learned the importance and value of

talking to my mentor and using her as a primary resource for tackling issues.


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References

Barker, p., (2003) Psychiatric and Mental Health Nursing: the Craft of Caring

(London: Hodder Arnold)

Department of Health (DoH) (2001) Preparation of Mentors and Teachers: a New

Framework of Guidance (London: the Stationary Office)

Freshwater, Dawn, (2002) Therapeutic Nursing: Improving Patient Care through

Self-Awareness and Reflection (London: SAGE)

Grossman, Sheila, (2007) Mentoring in Nursing: a Dynamic and Collaborative

Process (New York: Springer)

Hargie, Owen (2010) Skilled Interpersonal Communication: Research, Theory, and

Practice (London: Routledge)

Heron, J., (1990) Helping the Client: a Creative Practical Guide (London: SAGE)

Kunyk, D., and Olson, J.K., (2001) ‘Clarification of Conceptualisations of Empathy’

Journal of Advanced Nursing Vol.35 (3) pp.317-325

Rungapadiachy, D.,M., (1999) Interpersonal Communication and Psychology for

Health Care Professionals: Theory and Practice (Edinburgh: Butterworth-

Heinemann)


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Shrives, Louise Rebraca, (2008) Basic Concepts of Psychiatric-Mental Health

Nursing (London: Lippincott)


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Appendix A: Personal Action Plan

The following action plans are based on the SMART format:

S = Specific

M = Measurable

A = Attainable

R = Realistic

T = Time-Based

In the following diagrams, ‘goal’ equates to ‘specific’


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